HIV-related mortality in sub-Saharan Africa remains high, partly due to challenges with monitoring and intervening on patients presenting with advanced disease. Mobile health technologies, including biosensors and cellular phone platforms, among others, hold great promise to improve monitoring, communication and targeting of interventions to at-risk people living with HIV/AIDS (PLWHA). Yet, the majority of these technologies are not implemented due to inadequate attention to behavioral aspects of the human- technology interface. The Consortium for Affordable Medical Technologies (CAMTech), based at the Massachusetts General Hospital, is developing a robust portfolio of technologies for improving healthcare in resource limited settings (RLS). I will derive and validate a behavioral science framework of technology acceptance for novel, patient-centered technologies in RLS by evaluating 1 device in the CAMTech portfolio, a wireless biosensor for remote detection of abnormal vital signs. My overarching goal is to become a leader in the study of acceptance and implementation of low-cost medical technologies to improve healthcare delivery in RLS, using a foundation in behavioral theory to evaluate and address barriers to technology acceptance. To achieve independence, I require further training in: 1) qualitative research methods to derive a technology acceptance theoretical framework for patient-centered interventions in RLS; 2) behavioral theory and analysis methods focused on developing and testing technology acceptance frameworks in RLS; and 3) aspects of technology evaluation, including clinical research methods and technical elements of devices, to evaluate technology acceptance and communicate results with engineers. My mentoring team includes Dr. David Bangsberg, an expert in behavioral aspects of HIV treatment who leads CAMTech, and experts in qualitative methods (Ware), behavioral theory and technology acceptance (Safren, Venkatesh), technology design and implementation (Fletcher, Remien), and clinical study design and analysis in RLS (Lockman, Mulogo, Petersen). With their guidance, I will test my central hypothesis that behavioral theory can optimize the evaluation of novel technologies in RLS, through the following specific aims: 1) develop a technology acceptance model relevant to PLWHA in RLS using qualitative research methods; 2) derive and test scales to measure constructs in the emergent model from Aim 1; and 3) using the framework derived in Aims 1 and 2, perform a pilot study of acceptability and feasibility of the biosensor to identify abnormal vitl signs in at-risk PLWHA. The research plan is innovative because it will derive and test a framework applicable to the multitude of promising low-cost technologies to improve healthcare delivery in RLS. Further, it will position me to apply for an NIH R01 to test the efficacy of this and other devices. I am well positioned to accomplish these aims based upon my success conducting research in Uganda, strong mentoring team, and institutional support both in the United States and Uganda.
The current paradigm of HIV care in RLS does not optimally monitor patients or target interventions to those at risk of poor outcomes. Mobile health (mHealth) technologies, which are designed to strategically locate and deliver right-place, right-time interventions to the patients most in need, have been thwarted by a failure to evaluate behavioral aspects of their use in target populations. The proposed research is highly relevant to public health because it will leverage behavioral theory to evaluate and advance a public health paradigm, which will enable the delivery of interventions to high-risk PLWHA when and where they are most in need. These aims are closely aligned with trans-NIH goals to improve disease outcomes for PLWHA and to reduce HIV-related disparities in care.
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